Help needed for claiming ESA

[Alied]

Just found out my husband has been put in the WRAG of ESA without attending an interview/medical. he had open heart surgery 12 years ago and was told in around 12 years he would need it done again, so we are getting close to that time again. Since the operation 12 years ago he has suffered CRPS a chronic pain syndrome that mean his legs and feet are very painful all the time. He is on morphine based painkillers (amongst other things) and is in constant pain every time he puts his feet to the floor, and even just sitting down he has pain in his legs and feet. Psycholgically he is now a mess as he is now terrified that they are going to make him go back to work. Anyone know why he was not put in the support group? He has received DLA higher rate mobility and middle rate care for 10 years without any problem so is it worth appealing to see if he can be put in the support group? Please help!!

[Nystagmite]

You can only appeal if he meets the criteria for the support group.

[Alied]

How do I know if he fulfills the criteria? He finds walking painfull all the time so I thought that would get him maximum points on the walking bit and get him into the support group.

[honeybee13]

Hello there.

 

You should be able to find the criteria on the DWP website. Someone here may know, but it's worth googling it.

 

My best, HB

[honeybee13]

Me again.

 

I think you may find the information you need in the WCA handbook link below. Try from page 22 onwards.

 

http://www.dwp.gov.uk/docs/wca-handbook.pdf

 

HB

[Alied]

Thanks Honeybee. This is really useful information. It seems that they do take on board pain as well as physical restrictions, so an appeal may be worth considering. However, what I don't want to happen though is to appeal and then find a very unsympathetic DM who decides that my husband doesn't even qualify for the WRAG. Can I ask for the decision to be looked at again with further supporting evidence without going through the appeals route? Does an appeal mean my husband with definitely have to attend a medical as he was awarded ESA WRAG without attending a medical. He was on IB for 12 years without being sent for any medicals so is that why he didn't need a medical for ESA?

 

I think all this transferring to ESA is being done very underhand. The only way we knew about the IS being stopped was getting a letter from our mortgage company saying that the DWP has told them they wouldn't be paying the interest on our mortgage any more - nothing to us at all.

[MIKEY DABODEE]

Well i went to the CAB on Monday, they took some details and made an appointment for me with their benefits guy the next day.

 

We went through a lot of things, but a couple stuck out. First of all, he was really concerned that my partner had been placed in the work-related group without even being assessed. He said they only do that if you fail to turn up for an interview, and that got me fuming thinking that not only did they mess us about on the day, but would they turned round to the dwp and said we didn't even attend? If they do, how can we prove that we did attend but were sent home?

 

As for the joint income support aspect, he wasn't too keen on the idea. He had to get some mammoth text book to support what he was saying, but basically it came down to something like being on DLA does not mean that my partner is not qualified for full-time work, as people can work full-time and claim DLA. He thought it would be too easy for everyone who is on ESA and has a partner as a carer to opt out of the system by just hopping on to their partners income support, which would be a big hole in the system and would lose out of the system a large amount of people that ESA was designed for.

 

He specifically photocoped a section of the book:

 

Basically he was saying that without going on ESA, it would look like my partner is simply choosing not to work, and under those circumstances the dwp would not be likely to support the joint claim.

 

I'd love some feedback on this. I can see where he is coming from, but later i was mulling it over an thought that being eligible for ESA, as satisfied by Appendix 1 of the descriptors, would be "good cause"? Surely if she is eligible for esa, then she should eligible not to work? Or could that only be decided if she is placed in the support group?

 

Either way, i need to phone the dwp and see why they decided she was put into the work-related group without an assessment. I'll post back after i've phoned them.

 

 

The advice given in this case is absolute rubbish

People who receive DLA yes can work

and people who receive Carers Allowance are entitled to claim I.S, for themselves and partner if applicable

and tosh about the DWP not supporting the case.

and hiding from work no..

If a benefit is available and you entitled to claim it, then whats the problem..

Its your choice.......

[lucksic]

Mackerel,

Do appeal for your Partner to be placed into the support group. Contact MIND (Helpline Tel 0300 123 3393) as they can recommend a MH WR Specialist in your area.

[Nystagmite]

but basically it came down to something like being on DLA does not mean that my partner is not qualified for full-time work,

 

But he has been deemed too ill to work, hence ESA.

 

If the law states (which is does) that someone is entitled to IS, they have every right to claim - regardless of why they qualify. DWP will only turn you down if you don't meet the criteria. Whether that be because income / savings are too high, or whether you don't meet the other criteria. (if you receive carers allowance, you have an entitlement to IS)

 

You have been told rubbish. I would be tempted to complain.

[poollie1]

How do I know if he fulfills the criteria? He finds walking painfull all the time so I thought that would get him maximum points on the walking bit and get him into the support group.

 

Criteria for Support Group on mobilising is.. unable to mobilise 50 meteres unaided, or unable to mobilise 50 meteres with aides such as walking stick or crutches, or unable to mobilise in a manual wheelchair and unable to propel it yourself. He has to fulfill this criteria for entry into the Support Group if you were to appeal on this descriptor.

Edited April 6, 2012 by poollie1

[poollie1]

Thanks Honeybee. This is really useful information. It seems that they do take on board pain as well as physical restrictions, so an appeal may be worth considering. However, what I don't want to happen though is to appeal and then find a very unsympathetic DM who decides that my husband doesn't even qualify for the WRAG. Can I ask for the decision to be looked at again with further supporting evidence without going through the appeals route? Does an appeal mean my husband with definitely have to attend a medical as he was awarded ESA WRAG without attending a medical. He was on IB for 12 years without being sent for any medicals so is that why he didn't need a medical for ESA?

 

I think all this transferring to ESA is being done very underhand. The only way we knew about the IS being stopped was getting a letter from our mortgage company saying that the DWP has told them they wouldn't be paying the interest on our mortgage any more - nothing to us at all.

 

You can ask for a reconsideration within one month of the original decision letter, the whole claim will be looked at again by a different DM, but as you say this could have an adverse affect. I dont think being on IB for 12 years without having a medical is the reason for not needing a medical now, it will be more to do with sending enough information to Atos and DWP for them to make a decision without the need for a medical.

[Nystagmite]

Support group descriptors

 

1. Mobilising unaided by another person with or without a walking stick, manual wheelchair or other aid if such aid can reasonably be used.

Cannot either

(i) mobilise more than 50 metres on level ground without stopping in order to avoid significant discomfort or exhaustion

or

(ii) repeatedly mobilise 50 metres within a reasonable timescale because of significant discomfort or exhaustion.

 

2. Transferring from one seated position to another.

Cannot move between one seated position and another seated position located next to one another without receiving physical assistance from another person.

 

3. Reaching.

Cannot raise either arm as if to put something in the top pocket of a coat or jacket.

 

4. Picking up and moving or transferring by the use of the upper body and arms (excluding standing, sitting, bending or kneeling and all other activities specified in this Schedule).

Cannot pick up and move a 0.5 litre carton full of liquid.

 

5. Manual dexterity.

Cannot either:

(a) press a button, such as a telephone keypad or;

(b) turn the pages of a book

with either hand.

 

6. Making self understood through speaking, writing, typing, or other means normally used.

Cannot convey a simple message, such as the presence of a hazard.

 

7. Understanding communication by hearing, lip reading, reading 16 point print or using any aid if reasonably used.

Cannot understand a simple message due to sensory impairment, such as the location of a fire escape.

 

8. Absence or loss of control over extensive evacuation of the bowel and/or bladder, other than enuresis (bed-wetting) despite the presence of any aids or adaptations normally used.

(a) At least once a week experiences

(i) loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder; or

(ii) substantial leakage of the contents of a collecting device;

sufficient to require cleaning and a change in clothing.

 

9. Learning tasks.

(a) Cannot learn how to complete a simple task, such as setting an alarm clock, due to cognitive impairment or mental disorder.

 

10. Awareness of everyday hazards (such as boiling water or sharp objects).

(a) Reduced awareness of everyday hazards leads to a significant risk of:

(i) injury to self or others; or

(ii) damage to property or possessions,

such that they require supervision for the majority of the time to maintain safety.

 

11. Initiating and completing personal action (which means planning, organisation, problem solving, prioritising or switching tasks).

Cannot, due to impaired mental function, reliably initiate or complete at least 2 sequential personal actions.

 

12. Coping with change

(a) Cannot cope with any change, due to cognitive impairment or mental disorder, to the extent that day to day life cannot be managed.

 

13. Coping with social engagement due to cognitive impairment or mental disorder

Engagement in social contact is always precluded due to difficulty relating to others or significant distress experienced by the individual.

 

14. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder

Has, on a daily basis, uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace.

 

15. Conveying food or drink to the mouth.

(a) Cannot convey food or drink to the claimant’s own mouth without receiving physical assistance from someone else;

(b) Cannot convey food or drink to the claimant’s own mouth without repeatedly stopping, experiencing breathlessness or severe discomfort;

© Cannot convey food or drink to the claimant’s own mouth without receiving regular prompting given by someone else in the claimant’s physical presence; or

(d) Owing to a severe disorder of mood or behaviour, fails to

convey food or drink to the claimant’s own mouth without receiving —

(i) physical assistance from someone else; or

(ii) regular prompting given by someone else in the claimant’s presence.

 

16. Chewing or swallowing food or drink

(a) Cannot chew or swallow food or drink;

(b) Cannot chew or swallow food or drink without repeatedly stopping, experiencing breathlessness or severe discomfort;

© Cannot chew or swallow food or drink without repeatedly receiving regular prompting given by someone else in the claimant’s presence; or

(d) Owing to a severe disorder of mood or behaviour, fails to—

(i) chew or swallow food or drink; or

(ii) chew or swallow food or drink without regular prompting given by another person in the physical presence of the claimant.

 

Source

[lucksic]

This thread is confused by post 26 interrupting the original thread, we have two different posters and situations being addressed now? does a button need pressing

[mackerel]

This thread is confused by post 26 interrupting the original thread, we have two different posters and situations being addressed now? does a button need pressing

Confusing indeed!! Although i believe a part of that may be may fault for not posting back sooner and keep the thread on topic.

 

Latest update: we sent the appeal form (GL24) off, and the next day got a letter from jobcentreplus with a date for a WRAG personal advisor interview! It hasn't even been a month since we received the original decision letter, and i'm not sure the appeal has even been processed yet.

 

What shall i do about this? There is no way she can attend the interview, nor do i feel she should. I'm going to phone the dwp tomorrow to find out what the hell is going on, but on what grounds can i refuse my partner to attend the interview - on the basis that we are appealing the decision?

 

Mackerel,

Do appeal for your Partner to be placed into the support group. Contact MIND (Helpline Tel 0300 123 3393) as they can recommend a MH WR Specialist in your area.

Have appealed, but haven't got MIND involved, may be wise to, thanks for the tip. (What's a WR Specialist?)

 

Support group descriptors

9. Learning tasks.

(a) Cannot learn how to complete a simple task, such as setting an alarm clock, due to cognitive impairment or mental disorder.

 

10. Awareness of everyday hazards (such as boiling water or sharp objects).

(a) Reduced awareness of everyday hazards leads to a significant risk of:

(i) injury to self or others; or

(ii) damage to property or possessions,

such that they require supervision for the majority of the time to maintain safety.

 

11. Initiating and completing personal action (which means planning, organisation, problem solving, prioritising or switching tasks).

Cannot, due to impaired mental function, reliably initiate or complete at least 2 sequential personal actions.

 

12. Coping with change

(a) Cannot cope with any change, due to cognitive impairment or mental disorder, to the extent that day to day life cannot be managed.

 

13. Coping with social engagement due to cognitive impairment or mental disorder

Engagement in social contact is always precluded due to difficulty relating to others or significant distress experienced by the individual.

 

14. Appropriateness of behaviour with other people, due to cognitive impairment or mental disorder

Has, on a daily basis, uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace.

 

15. Conveying food or drink to the mouth.

© Cannot convey food or drink to the claimant’s own mouth without receiving regular prompting given by someone else in the claimant’s physical presence; or

(d) Owing to a severe disorder of mood or behaviour, fails to

convey food or drink to the claimant’s own mouth without receiving —

(ii) regular prompting given by someone else in the claimant’s presence.

She has these problems, for certain.

 

But he has been deemed too ill to work, hence ESA.

If the law states (which is does) that someone is entitled to IS, they have every right to claim - regardless of why they qualify. DWP will only turn you down if you don't meet the criteria. Whether that be because income / savings are too high, or whether you don't meet the other criteria. (if you receive carers allowance, you have an entitlement to IS)

 

You have been told rubbish. I would be tempted to complain.

 

The advice given in this case is absolute rubbish

People who receive DLA yes can work

and people who receive Carers Allowance are entitled to claim I.S, for themselves and partner if applicable

and tosh about the DWP not supporting the case.

and hiding from work no..

If a benefit is available and you entitled to claim it, then whats the problem..

Its your choice.......

 

i really appreciate the advice, i'm totally unsure how to proceed now to be honest. I can see the point that you two are making, and it makes sense, but i'm a little hesitant to change the position we change the way we claim benefits in case we end up in a worse situation eg would we still be eligible for housing benefit if we are not on ESA, but are just claiming income support? We already had a letter from our council saying the DWP had informed them that my partner was now on ESA.

 

I think i'll phone the dwp tomorrow and see what's going on, and then if it's more confusion, talk to my partner about taking the simple route and just claiming IS in my name as a joint claim.

 

I suppose if things are starting to get messy, we could do a joint IS claim under my name, then if it gets turned down we can reapply for ESA (for whatever reason, if we needed to)? If we done this, how long would it take for the joint claim to come into effect?

 

One question - if under the joint claim for IS i have to state that my partner does not work due to ill health (which they will obviously have records of as she is entitled to ESA) will they not defer her to ESA by default, and put us back to where we are now?

 

Edited April 9, 2012 by mackerel

[Nystagmite]

Have appealed, but haven't got MIND involved, may be wise to, thanks for the tip. (What's a WR Specialist?)

 

I think it's welfare rights.

[lucksic]

Yes welfare rights, Sorry for abbreviation. Please contact MIND asap!

[geriann]

ESA is not replacing IS

 

yes it is...at least until Universal Credit starts.

i'm on the disability rate of IS and have just received a letter to say they're reassessing everyone who's on IS or IB or Severe Disablement Allowance to move them on to ESA if they qualify.

[poollie1]

yes it is...at least until Universal Credit starts.

i'm on the disability rate of IS and have just received a letter to say they're reassessing everyone who's on IS or IB or Severe Disablement Allowance to move them on to ESA if they qualify.

 

Esa is not replacing Income Support.

[Nystagmite]

For people who receive IS due to disability it is.

[poollie1]

For people who receive IS due to disability it is.

 

Yes I know that, but it was inplied it was replacing Income Support full stop.

[flumps1976]

With regards to the adviser interview at the JCP office if your partner calls and then gives permission to speak to you, then you can discuss the ongoing issue with the adviser and although I am not a personal adviser at the JCP I would imgaine that the interview would be deferred for a few weeks to allow time for the appeal to be received at the DWP and for the appropriate action from the appeal to start.

When that time period is up hopefully you will know exactly what is going to happen with regards to the claim for IS.

 

ESA is not replacing IS it is replacing the Incapacity Benefit payments however as some people had not paid enough NI contributions previously to have entitlement to receive the actual Incapacity Benefit those people were paid Income Support on the grounds of Incapacity/Sickness.

[MIKEY DABODEE]

For people who receive IS due to disability it is.

 

no just people claiming IS on the grounds of IB

[mackerel]

Appealed the decision, got confirmation of the appeal in the post. Then spoke to the office that would be doing the personal advisor interview. I told them that due to us appealing the decision, and the fact that my partner suffers from mental health problems, she would not be able to attend. They said that the because the original decision on file is that she has been placed in the WRAG, she must attend all interviews until a new decision is made, as they are compulsory.

 

This is bad news, as i know from reading on here that appealing the grouping can take months, and i fear in the meantime that they will force my partner to attend all the wrag interviews.

[mackerel]

The advisor is due to phone some time tomorrow - is there anything i can say that will make them defer these interviews until the appeal is over? Would they speak to me instead of my partner (she doesn't do very well on the phone), to answer questions on her behalf?

[mackerel]

Well i finally got hold of the advisor before the interview, and we agreed to do a telephone interview. It went so-so, partner started getting quite agitated at some of the questions (what jobs did you have on your summer holidays when you were 14?!?!).

 

Anyway, the advisor mentioned she would need to arrange another interview in a month, as she said it would be unlikely that the appeal would be processed by then, my partner would need to attend that. Is that true, that the appeals take that long to be looked at?